posture assessment
Symptoms:
Pain in the left glute that travels down the leg when exacerbated. The pain is worse in the evenings.
Tests
Mckenzie extensions exacerbates the back
Positive slump test using the left leg indicates nerve involvement.
Craig’s test done visually shows about 15 degrees of external rotation.

 

Visual assessment:

Anterior

Externally rotated left leg

Bilateral externally rotated tibias

Side view:

A flat back which may contribute to the flexion dysfunction

Both knees are held in slight flexion

Active movements

Squat:

  • External rotation of tibias

Single leg stance

  • No dorsiflexion of left foot
  • Valgus collapse of both knees, mostly left

Gait analysis

  • The pelvis tilts excessively when standing on one leg especially the left leg indicating lengthened abductors.
Gait analysis internally rotated knee
  • The right leg is internally rotated at mid stance with compensatory lateral rotation of the tibia
Gait analysis reduced dorsiflexion
  • Heel rise occurs significantly earlier on the left foot due to the reduced ankle dorsiflexion (ankle rocker).
Gait analysis
  • The left leg has to externally rotate to clear the left foot from the floor due to reduced dorsiflexion.

Conclusion

The fact that the clients also tests positive for a slump test on the left leg means that there is also a flexion dysfunction and the pelvis should be kept in a neutral position during motor control exercises.

Manual therapy on the left foot to increase dorsiflexion of the left foot should help lower extremity biomechanics.

Treatment

  • The knees should move over the second toe sand should not pass the feet.
  • Effort should be made to externally rotate the knees and not to let them collapse inwards.
  • The right foot should not be allowed to move outwards (abduct)
  • A heel lift is worn under the left foot to allow for the squat.
  • Mild Single leg squats with a left heel raise
  • The pelvis should not be allowed to drop or the trunk lean to the side.
  • Popliteal exercises to improve internal rotation of the right knee
  • The foot is kept flat on the floor and the tibia internally rotated
  • A theraband can be used to make the exercise harder
  • Hip abductions against a wall with the lower back kept flat against the wall and should not curve
  • The heel should be touching the walls it moves up and down